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I am writing this for my sister who is struggling with guilt, anger, depression, anxiety, and burn out from caring for her husband with Alzheimer's. She has to make a very difficult decision about when is the time to put her husband in a home permanently. She is trying to arrange respite care for a weekend to open up the cottage with her two daughters. Any place she contacted would only take him for a week and she feels he won't be able to handle that, and by that, I also think she won't be able to handle that. She keeps saying he isn't ready for that? When do you know it is time to put your loved one in a facility and how do you tell them that's what is happening? And how can her daughters and I best support her during this process?

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tater72, your question is one I struggled with for a long time, but it was regarding a parent, which I think is easier to answer than when it's regarding a spouse. Even so, the decision to move my dad into the best memory care facility I could find and that was close enough for me to visit daily was a hard one to make. I do know that the opinions of siblings who were urging me not to move him to a facility (or to at least move him to a cheaper one several hours away), while not helping with his care, were not helpful and, in fact, I greatly resented their opinions. But it was also not very helpful for siblings who were more supportive of me when they urged me to move our dad to a facility. Maybe the fact that I was so resentful of any sibling who urged me to do anything was a telltale sign that it was time to do it, I don't know.

One thing that I kept in mind while making my decision was what a long-time Alzheimer's support group facilitator told me, that he never knew anyone who, after placing their loved one in a facility, said that they had done that too soon. He had placed his own 65-year-old wife in a memory care facility after many years of care-giving, but only after their children said they didn't want to lose their dad in addition to losing their mom.

This is obviously a hard decision for your sister. All I can advise is to listen to her when she wants to talk, be supportive, provide her with books and articles on the subject, and otherwise help her as much as you can, but don't urge her to take any specific action (except to take care of herself).
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This is a very difficult, but not impossible decision. It takes time to deal with all the feelings of placing a loved one in a facility. It’s not like one minute you’re feeling guilty and sad and the next you realize you have some freedom back and want to leave on a cruise. These feelings come and go for a long time.

It’s possible he’s NOT ready yet, as she says. There probably is no one who knows him better than she does. You don’t say what you have observed. But, even though what you’ve observed may indicate to you he needs to be in a facility, it may not indicate that to them. She has to be ok with the decision and get there in her own time. No one, even a beloved sister can tell her what she should do.

Be there to support both of them and help out if you can, without judgement. She will get there in her own time.
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Maybe it's your sister who isn't ready to put her husband in a nursing home as opposed to his not being ready to be placed in a nursing home.

Each family is different when it comes to when to put a loved one in a nursing home and depends upon the person's overall health, age, mobility, stage of dementia, etc. It also depends on the family. Who is caring for the person? Is there support for the caregiver? How is the caregiver's mental/emotional/physical health? So many factors have to be considered. Each situation is unique.

A basic litmus test might include whether the person is thriving at home or are they declining? A person can have dementia and still thrive. Business and medical issues aside, what goes into the actual care of the person and their body? Can the person do anything on their own? Not big things like cooking a meal but can they hold a toothbrush? Can they communicate in any way that they are tired, cold, hungry, etc.? is the caregiver overwhelmed with caring for the person?

The best way to support your sister is to allow her to be ambivalent about placing her husband in a nursing home. You may think he needs to be in a facility but unless she asks, let your sister figure it out and come to terms with it. Be supportive of her choices and her hesitancy. That's her husband. On our wedding day most of us looked into the future and saw ourselves in our elder years covered in grandchildren and taking great trips. We didn't see Alzheimer's and nursing homes. Your sister, in her hesitancy, may be trying to find a way to make it right so that she can live with it. It's an extremely difficult decision with many ramifications. Support her no matter what your opinions are. And try not to offer your opinion unless asked.

I suspect she might realize her husband needs a nursing home and is trying to make it OK in her mind. OK for her husband and OK for herself.
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Tater, if your sister is dealing with her own anger, depression, anxiety and burn out, right there is the answer. It is time. But it sounds like your sister is in denial. Tell her that almost 40% of caregivers pass away leaving behind the love one they were caring... not good odds. What if something happened to her?

Guilt of putting a love one in a skilled facility is very common. Your sister would need to keep telling herself that hubby does need a higher level of skilled care than what she can supply. I had to use that thought when my own Mom had to go to long-term-care. I knew she was safe there, and getting some rehab to help her, but I also knew she would never be coming back home to my Dad.

Usually we need to wait until a love one has a serious fall or an illness and we call 911.... stay time in the hospital... then stay time in Rehab. After Rehab is the best time to move a love one into continuing care. Then one could use what are called "theraputic fibs" to calm hubby as to why he isn't home. Such as "the doctor says you can't come home until you are able to do________", or "this place is another rehab". It is ok to use these fibs in the best interest of the patient.

Once hubby is in continuing care, there are also things recommended that your sister would need to do. Oh by the way, the continuing care facility will assess your sister's husband to see if he in fact does qualify to be in the facility.
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